Perspectives An Open Invitation to Cultural Anthropology Textbook Chapter 17

17 HEALTH AND MEDICINE , Pasadena City College Learning Objectives Define the perspective and provide examples of how interactions between biology and culture have affected human biology . Identify four ( personalistic , naturalistic , and biomedical ) and describe how each differs in ing the root cause of illness . Explain the significance of faith in healing . Examine the relationship between mental health and cultural factors , including stigma , that affect the way people with mental health conditions are perceived . Discuss examples of syndromes . Evaluate the positive and negative effects of biomedical technologies . What does it mean to be healthy ?

It may seem odd to ask the question , but health is not a universal concept and each culture values different aspects of . At the most basic level , health may be perceived as surviving each day with enough food and water , while other definitions of health may be based on being free of diseases or emotional troubles . Complicating things further is the fact that that each culture has a different causal explanation for disease . For instance , in ancient Greece health was considered to be the product of unbalanced humors or bodily . The four humors included black bile , phlegm , yellow bile , and blood . The ancient Greeks believed that interactions among these humors explained differences not only in health , but in age , gender , and general disposition . Various 425

426 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL things could the balance of the humors in a persons body including substances believed to be present in the air , changes in diet , or even temperature and weather . An imbalance in the humors was believed to cause diseases , mood problems , and mental The World Health Organization ( WHO ) recognizes that the health of individuals and communities is affected by many factors where we live , the state of our environment , genetics , our income and cation level , and our relationships with friends and Research conducted by the WHO suggests that these characteristics play a more significant role in affecting our health than any others , ing having access to health care . For this reason , anthropologists who are interested in issues related to health and illness must use a broad holistic perspective that considers the of both biology and culture . Medical anthropology , a distinct within the discipline of anthropology , gates human health and health care systems in comparative perspective , considering a wide range of dynamics that affect the of human populations . Medical anthropologists study the perceived causes of illness as well as the techniques and treatments developed in a society to address health concerns . Using cultural relativism and a comparative approach , medical anthropologists seek to understand how ideas about health , illness , and the body are products of particular social and cultural . ANTHROPOLOGY AND THE PERSPECTIVE Evolutionary biology is a field of study that investigates the ways that natural processes have shaped the development of life on Earth , producing measurable changes in populations over time . Humans , Homo sapiens , are a special case in the discussion of evolution . We are a relatively young species that has been on Earth for only about Although this may sound like a long time , pared with other animals , humans are newcomers and we have been subject to processes of natural selection and adaptation for less time than many other living things . In that short time period , human lifestyles have changed dramatically . The first humans evolved in Africa and had a foraging lifestyle , living in small , groups . Today , millions of people live in crowded , and advanced agricultural societies . In evolutionary terms , this change has happened rapidly . The fact that these rapid changes were even possible reveals that human lifestyles are , products of interactions between biology and culture . This has many implications for understanding human health . The theory of natural selection suggests that in any species there are certain physical or behavioral traits that are adaptive and increase the capacity of individuals to survive and reproduce . These tive traits will be passed on through generations . Many human traits contributed to the survival of early human communities . A capacity for efficient walking and running , for instance , was important to human survival for thousands of years . However , as cultural change led to new lifestyles , some human characteristics became . One example is the obesity epidemic that has emerged all over the world . According to the Center for Disease Control and Prevention , more than of the population of the United States is Obesity is considered to be a disease of civilization , meaning that it did not exist in early human . Taking a evolutionary approach to human health , we can ask what traits of early human foraging populations might have encouraged an accumulation of fat in the human body . The answer comes from the evidence of food shortages among foraging populations . In fact , 47 percent of societies that forage experience food shortages at least once per year . Another 24 percent experience a shortage at least every two When taking this into account , the ability to retain body fat would have been advantageous for humans in the past . Women with more body fat could give birth to healthy babies and breastfeed them , even in periods of food scarcity . It is also possible that women

427 and men would have viewed body fat as a sign of health and access to resources , choosing sexual based on this characteristic . If so , powerful biological and cultural forces would have contributed to genetic traits that led to efficient metabolism and higher body fat . With the development of agriculture , calories became more easily available while many people in the population became more sedentary . Traits that were once adaptive became . The ment of cultural preferences for foods high in fat and sugar , such as the standard American diet ( SAD ) is directly associated with obesity . These cultural changes have had a negative impact on health in many places . In , for instance , obesity rates were around 15 percent in traditional farming , but climbed to over 35 percent as people moved to This is an example of the nature of many human health challenges . Another example of this dynamic is sickle cell anemia , an inherited disease that can be fatal . A person who inherits the sickle cell gene from both parents will have red blood cells with an usual sickle ( crescent ) shape . These cells can not carry oxygen as efficiently as normal red blood cells and they are also more likely to form painful and dangerous blood clots . Ordinarily , genetic conditions that make it more difficult for individuals to survive or have children , will become less common in populations over time due to the effects of natural selection . From an evolutionary perspective , one might ask why a deadly genetic condition has remained so common in human populations . The cultural context is important for answering this question . The sickle cell gene is found most often in human populations in Africa and Southeast Asia where malaria is widespread . Malaria is a borne illness that can be deadly to humans . People who have inherited one copy of the sickle cell anemia trait ( instead of the two copies that cause sickle cell disease ) have resistance to malaria . This is a adaptive trait in parts of the world where malaria is Widespread . There is some evidence that malaria became a significant threat to human health only after the invention of agriculture . The areas and collections of standing water that characterize agricultural communities also attract the mosquitos that carry disease . In this case , we can see dynamics in action . Because resistance to malaria is an adaptive trait , the sickle cell gene remained common in populations where malaria is present . In parts of West and Central Africa , up to 25 percent of the population has the sickle cell gene . While sickle cell anemia is still a deadly disease , those who inherit a single copy of the gene have some protection from malaria , itself a deadly threat in many places . This example illustrates the interaction between genes , pathogens , and culture . Infectious diseases generally do not have an adaptive function for humans like the examples above , but many infectious diseases are by human cultural systems . Because early human consisted of small groups with a foraging lifestyle , viruses and bacteria transmitted from son to person were unlikely to result in epidemics . Healthy individuals from neighboring groups could simply avoid coming into contact with anyone who was suffering from illness and breaks would be naturally The rapid increase in the size of human communities following the invention of agriculture changed this pattern . Agriculture can support more people per unit of land and , at the same time , need to live in permanent urban settlements in order to care for their crops . In a cyclical way , culture provides more food while also requiring that people have sizeable families to do the necessary farm work . Over the course of several thousand years , agricultural communities became increasingly densely populated . This had many implications for local ecology problems disposing of waste and accessing clean water . A prime example of the health effects of the transition to urban settlements is cholera , a illness that spreads through water that has been polluted with human feces . Cholera , which was first detected in urban populations in India , has killed tens of thousands of people

428 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL ANTHROPOLOGY throughout history and continues to threaten populations today , particularly in developing countries , where access to clean water is limited , and in places that have experienced natural From an adaptive perspective , human beings die from infectious diseases because they do not have immunity to them . Immunity can be built up over time for some diseases , but unfortunately only after the illness or death of many members of a population ) When a new infectious disease reaches a , it can wreak havoc on many people . Historically , several new infectious diseases are known to have been introduced to human populations through contact with livestock . Tuberculosis and smallpox were linked to cattle and to chickens . When humans domesticated animal species , and began to live in close proximity to them , new routes for the transmission of zoonotic disease , illnesses that can be passed between humans and animals , were Living in cities accelerates the spread of infectious diseases and the scale of outbreaks , but may also contribute to the natural selection of genetic traits that confer resistance to disease . This evolutionary process has been documented in urban populations where there are genes providing some resistance to leprosy and is the comparative study of cultural ideas about wellness , illness , and healing . For the ity of our existence , human beings have depended on the resources of the natural environment and on health and healing techniques closely associated with spiritual beliefs . Many such practices , including some herbal remedies and techniques like acupuncture , have been studied scientifically and found to be Others have not necessarily been proven medically effective by external scientific evidence , but continue to be embraced by communities that perceive them to be ful . When considering cultural ideas about health , an important place to start is with cultural explanations about the underlying causes of health problems . In the United States the dominant approach to ing about health is biomedical . Illnesses are thought to be the result of specific , identifiable agents . This can include pathogens ( viruses or bacteria ) malfunction of the body biochemical processes ( conditions such as cancer ) or physiological disorders ( such as organ failure ) In as it is practiced in the United States ( Western ) health is defined as the absence of disease or dysfunction , a perspective that notably excludes consideration of social or spiritual . In biomedical explanations are often viewed as tory . In his analysis of ideas about health and illness in cultures , George Foster ( 1976 ) concluded that these ideas could be categorizes into two main types of personalistic and Figure Traditional Tibetan Medicine Poster .

429 Personalistic and Naturalistic Personalistic View disease as the result of the active , purposeful intervention of an agent , who may be human ( a witch or sorcerer ) nonhuman ( a ghost , an ancestor , an evil spirit ) or supernatural ( a deity or other very powerful being ) 15 Illness in this kind of is viewed as the result of aggression or punishment directed purposefully toward an individual there is no dent or random chance involved . Practitioners who are consulted to provide treatment are interested in discovering who is responsible for the ghost , an ancestor ?

No one is particularly interested in discovering how the medical condition arose in terms of the anatomy or biology involved . This is because treating the illness will require neutralizing or satisfying a person , or a supernatural entity , and correctly identifying the being who is the root cause of the problem is essential for achieving a cure . The people of southern provide an interesting example of a personalistic . As described by , in the , the members of this society had a strong belief that illness and other misfortune was the result of witchcraft . A certain magic , mysteriously appearing in individuals , causes the death or illness of anyone who eats their grain or spills their beer . Even spectacular success , wealth too quickly won , is suspect for it is the work of a , who steals grain or livestock for his human twin . This universe full of nant forces is in a bewildering array of rituals , fixed and occasional , which mark almost every activity of tribal Because sickness is thought to be caused by spiritual attacks from others in the community , people who become sick seek supernatural solutions . The person consulted is often a shaman , a person who specializes in contacting the world of the spirits . In culture , as well as in other societies where shamans exist , the shaman is believed to be capable of entering a state in order to cross between the ordinary and supernatural realms . While in this state , the shaman can identify the individual responsible for causing the illness and sometimes the spirits can be convinced to cure the disease itself . Shamans are common all around the world and despite the proverbial saying that prostitution is the oldest profession , shamanism is ! Shamans are religious and medical practitioners who play important social roles in their as healers with a transcendent ability to navigate the spirit world for answers . In addition , the often have a comprehensive knowledge of the local ecology and how to use plants medicinally . They can address illnesses using both natural and supernatural tools . In naturalistic , diseases are thought to be the result of natural forces such as cold , heat , winds , dampness , and above all , by an upset in the balance of the basic body 17 The ancient Greek idea that health results from a balance between the four humors is an example of a explanation . The concept of the yin and yang , which represent opposite but complementary energies , is a similar idea from traditional Chinese medicine . Achieving balance or harmony between these two forces is viewed as essential to physical and emotional health . Unlike personalistic nations , practitioners who treat illness in societies with naturalistic are interested in understanding how the medical condition arose so that they can choose therapeutic remedies viewed as most appropriate . Emotional difficulties can be viewed as the cause of illness in a naturalistic ( an explanation ) One example of a medical problem associated with emotion is , an illness recognized by the , an indigenous group who live in , Mexico , as well as others out central America . The symptoms of include difficulty sleeping , lack of energy , loss of appetite and sometimes and fever . The condition is believed to be a result of a fright or shock and , in some cases at least , it is believed to begin with a shock so strong that it disengages the soul from

430 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL ANTHROPOLOGY the The condition is usually treated with herbal remedies and ( sweeping ) ceremonies designed to repair the harm caused by the shock Although physicians operating within a medical have suggested that is a psychiatric illness that in other cultural could be labeled anxiety or depression , in fact is does not fit easily into any one Western ical category . Those suffering from see their condition as a malady that is emotional , spiritual , and In practice , people assess medical problems using a variety of explanations and in any given society personalistic , naturalistic , or even biomedical explanations may all apply in different situations . It is also important to keep in mind that the line between a medical concern and other kinds of life can be blurry . An illness may be viewed as just one more instance of general misfortune such as crop failure or disappointment in love . Among the in Central Africa , witchcraft is thought to be responsible for almost all misfortune , including illness . an anthropologist who studied the of Africa in the , famously described this logic be describing a situation in which a granary , a building used to store grain collapsed . In sometimes an old granary collapses . There is nothing remarkable in this . Every knows that termites eat the supports in course of time and that even the hardest woods decay after years of service . Now a granary is the summerhouse of a homestead and people sit beneath it in the heat of the day and chat or play the African or work at some craft . Consequently it may pen that there are people sitting beneath the granary when it collapses and they are injured Now why should these particular people have been sitting under this particular granary at the particular moment when it collapsed ?

That it should collapse is easily intelligible , but why should it have collapsed at the particular moment when these particular people were sitting beneath it The knows that the supports were undermined by termites and that people were sitting beneath the granary in order to escape the heat of the sun . But he knows besides why these two events occurred at a precisely similar moment in time and space . It was due to the action of witchcraft . If there had been no witchcraft ple would have been sitting under the granary and it would not have fallen on them , or it would have collapsed but the people would not have been sheltering under it at the time . Witchcraft explains the coincidence of these two According to this logic , an illness of the body is ultimately caused by the same force as the collapse of the granary witchcraft . In this case , an appropriate treatment may not even be focused on the body itself . Ideas about health are often inseparable from religious beliefs and general cultural assumptions about Is Western An ?

The biomedical approach to health strikes many people , particularly residents of the United States , as the best or at least the most fact based approach to medicine . This is largely because Western medicine is based on the application of insights from science , particularly biology and chemistry , to the diagnosis and treatment of medical conditions . The effectiveness of biomedical treatments is assessed through rigorous testing using the scientific method and indeed Western has produced successful treatments for many dangerous and complex conditions everything from antibiotics and cures for cancer to organ transplantation . However , it is important to remember that the biomedical approach is itself embedded in a distinct cultural tradition , just like other . and the scientific disciplines on which it is based , are products of Western history . The earliest Greek physicians Hippocrates ( and Galen ( 200 AD ) shaped the development of the biomedical perspective by providing early

insights into anatomy , physiology , and the relationship between environment and health . From its gins in ancient Greece and Rome , the knowledge base that matured into contemporary Western medicine developed as part of the Scientific Revolution in Europe , slowly maturing into the medical profession recognized today . While the scientific method used in Western represents a tinct and powerful way of knowing compared to other , the methods , procedures , and forms of reasoning used in are products of Western culture . 23 In matters of health , as in other aspects of life , ethnocentrism predisposes people to believe that their own culture traditions are the most effective . People from cultures do not necessarily agree that Western is superior to their own . Western culture does not even have a monopoly on the concept of Other cultures recognize their own forms of science separate from the Western tradition and these sciences have histories dating back hundreds or even thousands of years . One example is Traditional Chinese cine ( a set of practices developed over more than years to address physical complaints holistically through acupuncture , exercise , and herbal remedies . The tenets of Chinese Medicine are not based on science as it is defined in Western culture , but millions of people , including a growing number of people in the United States and Europe , regard as credible and effective . Ultimately , all are rooted in shared cultural . Figure The bladder , one of several perceptions about the way the World ( Western ' medicine cine practitioners would correctly observe that the strength of Western is derived from use of a scientific method that emphasizes objectively observable facts . However , this this would not be particularly persuasive to someone whose culture uses a different or whose understanding of the world derives from a different tradition of From a comparative perspective , Western may be viewed as one in a world of many alternatives . Techniques for Healing Western tends to conceive of the human body as a kind of biological machine . When parts of the machine are damaged , defective , or out of balance , chemical or surgical interventions are the preferred therapeutic responses . Biomedical practitioners , who can be identified by their white coats and , are trained to detect observable or quantifiable symptoms of disease , often through the use of advanced imaging technologies or tests of bodily like blood and urine . detected through these means will be addressed . Other factors known to contribute to wellness , such as the patients social relationships or emotional state of mind , are considered less relevant for both diagnosis and treatment . Other forms of healing , which derive from , reverse this formulation , giving priority to the social and spiritual . In Traditional Chinese Medicine , the body is thought to be governed by the same forces that animate the universe itself . One of these is chi ( qi ) a vital life force that through the body and energizes the body and its organs . Disruptions in the or balance of chi can lead to a lack of internal harmony and ultimately to health problems so practitioners use treatments designed to unblock or redirect chi ,

432 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL including acupuncture , dietary changes , and herbal remedies . This is an example of humoral healing , an approach to healing that seeks to treat medical ailments by achieving a balance between the forces or elements of the body . Communal healing , a second category of medical treatment , directs the combined efforts of the community toward treating illness . In this approach , medical care is a collaboration between multiple people . Among the ) of the Desert in southern Africa , energy known as num can be channeled by members of the community during a healing ritual and directed toward als suffering from illness . Richard , Megan , and Verna Davis ( 1982 ) described an example of this kind of ceremony The central event in this tradition is the healing dance . Four times a month on the average , night signals the start of a healing dance . The women sit around the fire , singing and rhythmically ping . The men , sometimes joined by the women , dance around the singers . As the dance intensifies , num , or spiritual energy , is activated by the healers , both men and women , but mostly among the ing men . As num is activated in them , they begin to kid , or experience an enhancement of their . While experiencing kia , they heal all those at the While communal healing techniques often involve harnessing supernatural forces such as the num , it is also true that these rituals help strengthen social bonds between people . Having a strong social and emotional support system is an important element of health in all human cultures . Faith and the Placebo Effect Humoral and communal approaches to healing , which from a scientific perspective would seem to have little potential to address the root causes of an illness , present an important question for medical anthropologists . What role does faith play in healing ?

Sir William , a Canadian physician who was one of the founders of johns Hopkins Hospital , believed that much of a physician healing ability derived from his or her ability to inspire patients with a faith that they could be wrote Faith in the Gods or in the Saints cures one , faith in little pills another , suggestion a third , faith in a plain common doctor a fourth a poor lass , paralyzed apparently , helpless , for years , comes to me having worn out in mind , body , and estate a devoted family if she in a few weeks or less by faith in me , and faith alone , takes up her bed and walks , the Saints of old could not have done In fact , there is a considerable amount of research suggesting that there is a placebo effect involved in many different kinds of healing treatments . A placebo effect is a response to treatment that occurs because the person receiving the treatment believes it will work , not because the treatment itself is tive . In Western , the placebo effect has been observed in situations in which a patient believes that he or she is receiving a certain drug treatment , but is actually receiving an inactive substance such as water or sugar . 27 Research suggests that the body often responds physiologically to placebos in the same way it would if the drug was The simple act of writing a prescription can contribute to the successful recovery of individuals because patients trust that they are on a path that will lead to If we consider the role of the placebo effect in the examples above , we should consider the possibility that humoral and communal healing are perceived to work because the people who receive these remedies have faith in them . An interesting example of the complexity of the connection is found in studies of prayer prayers made to request healing for another person . In one study , researchers separated patients who had recently undergone heart surgery into two groups , one people who know they would be receiving prayers for their recovery and another group who

433 would receive prayers without being aware of it . Those patients who knew they were receiving prayers actually had more complications and health problems in the month following This an interesting relationship between faith and healing . Why did the patients who knew that others were praying for them experience more complications ?

Perhaps it was because the knowledge that their had asked others to pray for them made patients more stressed , perceiving that their health was at greater risk . However , it can also be a lack of faith that drives people to look for alternative treatments . In the United States , alternative treatments , some of which are drawn from humoral or communal ing traditions , have become more popular among patients who believe that Western is failing them . Cancer research facilities have begun to suggest acupuncture as a treatment for the intense nausea and fatigue caused by and scientific studies suggest that acupuncture can be effective in relieving these Marijuana , a drug that has a long recorded history of medical use starting in ancient China , Egypt , and India , has steadily gained acceptance in the United States as a treatment for a variety of ranging from anxiety to As growing numbers of people place their faith in these and other remedies , it is important to recognize that many alternative forms of healing or medicine lack scientific evidence for their efficacy . The results derived from these practices may owe as much to faith as medicine . Figure A store selling herbal folk medicines . MENTAL HEALTH Unlike other kinds of illnesses , which present relatively consistent symptoms and clear biological , mental health disorders are experienced and treated differently . While the of psychiatry within Western applies a to explain mental illness , there is a consensus in medical anthropology that mental health conditions are much more complicated than the biological illness model suggests . These illnesses are not simply biological or chemical ders , but complex responses to the environment , including the web of social and cultural relationships to which individuals are connected . Medical anthropologists do not believe there are universal categories of mental Instead , individuals may express psychological distress through a variety of physical and emotional symptoms . Arthur , a medical anthropologist , has argued that every culture frames mental health differently . The pattern of symptoms associated with mental health conditions vary greatly between cultures . In China , discovered that patients suffering from depression did not describe feelings of sadness , but instead complained of boredom , discomfort , feelings of inner pressure , and symptoms of pain , dizziness , and Mental health is closely connected with social and cultural expectations and mental illnesses can arise as a result of pressures and challenges individuals face in particular settings . Rates of depression are higher for refugees , immigrants , and others who have experienced dislocation and loss . A sense of also seems to play a role in triggering anxiety and depression , a phenomenon that has been

434 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL documented in groups ranging from mothers in England to Native Americans affected by poverty and social Schizophrenia , a condition with genetic as well as environmental components , provides another interesting example of variation . Unlike anxiety or depression , there is some consistency in the symptom patterns associated with this condition cross culturally hallucinations , delusions , and social withdrawal . What differs , however , is the way these symptoms are viewed by the community . In his research in Indonesia , Robert discovered that symptoms of schizophrenia are often viewed by Indonesian communities as examples of communication with the spirit world , spirit sion , or the effects of traumatic Documenting the lives of some of these individuals in a film series , he noted that they remained integrated into their communities and had significant as members of their families and neighborhoods . People with schizophrenia were not , as often happens in the United States , confined to institutions and many were living with their condition out any biomedical treatments . In its study of schizophrenia in 19 countries , the World Health Organization concluded that societies that were more culturally accepting of symptoms associated with schizophrenia grated people suffering from the condition into community life more completely . In these cultures , the illness was less severe and people with schizophrenia had a higher quality of This finding has been controversial , but suggests that stigma and the resulting social isolation that characterize responses to mental illness in countries like the United States affect the subjective experience of the illness as well as its THE EXPERIENCE OF ILLNESS IN PLACE Social Construction of Illness As the above examples demonstrate , cultural attitudes affect how medical conditions will be and how individuals with health problems will be regarded by the Wider community . There is a difference , for instance , between a disease , which is a medical condition that can be objectively , and an illness , which is the subjective or personal experience of feeling unwell . Illnesses may be caused by disease , but the experience of being sick encompasses more than just the symptoms caused by the disease itself . Illnesses are , at least in part , social constructions experiences that are given meaning by the relationships between the person who is sick and others . The course of an illness can worsen for instance , if the dominant society views the sickness as a moral failing . Obesity is an excellent example of the social construction of illness . The condition itself is a result of culturally induced habits and attitudes toward food , but despite this strong cultural ponent , many people regard obesity as a preventable circumstance , blaming individuals for becoming overweight . This attitude has a long cultural history . Consider for instance the religious connotations within Christianity of gluttony as a Such socially constructed stigma the subjective experience of the illness . Obese women have reported avoiding visits to physicians for fear of judgment and as a result may not receive treatments necessary to help their Peter , a surgeon and medical researcher who delivered a TED Talk on this subject , related the story of an obese woman who had to have her foot amputated , a common result of complications from obesity and diabetes . Even though he was a physician , he judged the woman to be lazy . If you had just tried even a little bit , he had thought to himself before surgery . Subsequently , new research revealed that insulin resistance , a precursor to diabetes , often develops as a result of the excess sugars used in many kinds of processed foods consumed commonly in the United

435 States . As observes , high rates of obesity in the United States are a of the types of foods Americans have learned to consume as part of their cultural In addition , the fact that foods that are high in sugars and fats are inexpensive and abundant , while healthier foods are expensive and unavailable in some communities , highlights the economic and social inequalities that contribute to the disease . The virus provides another example of the way that the subjective experience of an ness can be by social attitudes . Research in many countries has shown that people , ing healthcare workers , make distinctions between patients who are innocent victims of AIDS and those who are viewed as People who HIV through sex or intravenous drug use are seen as guilty . The same judgment applies to HIV ?

relationships in places where societal disapproval of relationships exists . People who HIV from blood transfusions , or as babies , are viewed as innocent . The guilty HIV patients often find it more difficult to access medical care and are treated with disrespect or indifference in medical settings compared with superior treatment provided to those regarded as In the wider community , guilty patients suffer from social and exclusion while innocent patients receive greater social acceptance and practical assistance in responding to their needs for port and The stigma that applies to guilty patients also ignores the socioeconomic context in which AIDS spreads . For instance , in Indonesia , poor women can make considerably more money as sex workers than in many other jobs 10 an hour as a sex worker compared to 20 cents an hour in a Sex work may be the only form of employment available in a patriarchal society . In a similar way , poverty and a lack of other choices contribute to a decision to engage in sex work in other , including in Africa where rates of HIV infection are among the highest in the world . Poverty itself is one of the greatest risk factors for HIV The clear relationship between poverty , gender , and HIV infection has been the topic of a great deal of research in medical . One example is Paul Farmer classic book , AIDS and Accusation Haiti and the Geography of Blame ( 1992 ) which was one of the earliest books to critically evaluate the connection between poverty , racism , stigma , and neglect that allowed HIV to infect and kill thousands of Haitians . Projects like this are critical to developing holistic views of the entire cultural , economic , and political context that affects the spread of the virus and attempts to treat the disease . Partners in Health , the medical organization Paul Farmer helped to found , continues to pursue innovative strategies to prevent and treat diseases like AIDS , strategies that recognize that poverty and social provide the environment in which the virus . Syndromes A syndrome is an illness recognized only within a specific culture . These conditions , which combine emotional or psychological with physical symptoms , are not the result of a disease or any identifiable physiological dysfunction . Instead , syndromes are somatic , meaning

436 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL they are physical manifestations of emotional pain . The existence of these conditions demonstrates the profound of culture and society on the experience of illness . Anorexia Anorexia is considered a culture bound syndrome because of its strong association with cultures that place a high value on thinness as a measure of health and beauty . When we consider concepts of beauty from cultures all over the world , a common view of beauty is one of someone with additional fat . This may be because having additional fat in a place where food is expensive means that one is likely of a higher status . In societies like the United States where food is abundant , it is much more difficult to become thin than it is to become heavy . Although anorexia is a complex condition , medical and physicians have observed that it is much more common in Western cultural among people with high socioeconomic Anorexia , as a form of , has deep roots in Western culture and for centuries practices of have been associated with Christian religious traditions . In a contemporary context , anorexia may address a similar , but secular desire to assert control , particularly among During her research in , Anne Becker ( 2004 ) noted that young women who were exposed to and television programs from Western cultures ( like the United States and Australia ) became about their bodies and began to alter their eating habits to emulate the thin ideal they saw on television . Anorexia , which had been unknown in , became an increasingly common The same pattern has been observed in other societies undergoing through exposure to foreign media and economic changes associated with Swallowing Frogs in Brazil In Brazil , there are several examples of syndromes that affect children as well as adults . Women are particularly susceptible to these conditions , which are connected to emotional distress . In parts of Brazil where poverty , unemployment , and poor physical health are common , there are cultural norms that discourage the expression of strong emotions such as anger , grief , or jealousy . Of course , people continue to experience these emotions , but can not express them openly . Men and women deal with this problem in different ways . Men may choose to drink alcohol heavily , or even to express their anger physically by lashing out at others , including their wives . These are not socially acceptable for women who instead remark that they must suppress their feelings , an act they describe as ing to swallow frogs ( nerves ) is a syndrome characterized by symptoms such as headaches , bling , dizziness , fatigue , stomach pain , tingling of the extremities and even partial paralysis . It is viewed as a result of emotional overload a state of constant vulnerability to shock . Unexplained wounds on the body may be diagnosed as a different kind of illness known as Since emotion is culturally defined as a kind of energy that throughout the body , many believe that too much emotion can overwhelm the body , boiling over and producing symptoms . A person can become so angry , for instance , that his or her blood spills out from under the skin , creating bruises , or so angry that the blood rises up to create severe headaches , nausea , and dizziness . A third form of illness , known as ( open chest ) is believed to be occur when a person , most often a woman , is carrying too much emotional weight or suffering . In this situation , the heart expands until the chest becomes spiritually A chest that is open is dangerous because rage and anger from other ple can enter and make a person

437 In stressful settings like the communities in impoverished areas of northeastern Brazil , it is common for people to be afflicted with illnesses throughout their lives . Individuals can suffer from one condition , or a combination of several . Sufferers may consult , Catholic faith healers who will treat the condition with prayer , herbal remedies , or healing rituals . Because these practitioners do not distinguish between illnesses of the body and mind , they treat the symptoms as evidence of personal turmoil . This approach to addressing these illnesses is consistent with cultural views that it is the suppression of emotion itself that has caused the physical problems . BIOMEDICAL TECHNOLOGIES In the history of human health , technology is an essential topic . Medical technologies have transformed human life . They have increased life expectancy rates , lowered child mortality rates , and are used to intervene in and often cure thousands of diseases . Of course , these accomplishments come with many cultural consequences . Successful efforts to intervene in the body biologically also have implications for cultural values and the social organization of communities , as demonstrated by the examples below . Antibiotics and Infectious diseases caused by viruses and bacteria have taken an enormous toll on human populations for thousands of years . During recurring epidemics , tens of thousands of people have died from breaks of diseases like measles , the , or bubonic plague . The Black Death , a pandemic outbreak of plague that spread across Europe and from AD , killed as many as 200 million people , as much as a third of the European population . Penicillin , discovered in 1928 and mass produced for the first time in the early , was a turning point in the human fight against bacterial infections . Called a wonder drug by Time magazine , Penicillin became available at a time when bacterial infections were frequently fatal the drug was glorified as a An important factor to consider about the duction of antibiotics is the change to an understanding of illness that was increasingly scientific and technical . Before science could provide cures , personalistic and naturalistic identified various root causes for sickness , but the invention of antibiotics contributed to a strengthening of the Western biomedical paradigm as well as a new era of profitability for the pharmaceutical industry . The effects of antibiotics have not been completely positive in all parts of the world . Along with other technological advances in areas such as sanitation and access to clean water , antibiotics contributed to an epidemiological transition characterized by a sharp drop in mortality rates , particularly among children . In many countries , the immediate effect was an increase in the human population as well as a shift in the kinds of diseases that were most prevalent . In wealthy countries , for instance , chronic like heart disease or cancer have replaced bacterial infections as leading causes of death and the average lifespan has lengthened . In developing countries , the outcome has been mixed . Millions of lives have been saved by the availability of antibiotics , but high poverty and lack of access to regular medical care mean that many children who now survive the immediate dangers of infection during infancy later in childhood to malnutrition , dehydration , or other

438 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL ANTHROPOLOGY Figure Women and children waiting to enter a medical clinic in . The clinic IS open days each week and treats 400600 people each day . Another difficulty is the fact that many kinds of infections have become untreatable as a result of resistance . Medical anthropologists are concerned with the increase in rates of infectious diseases like tuberculosis and malaria that can not be treated with many existing antibiotics . According to the World Health Organization , there are nearly cases of drug resistant tuberculosis each New research is now focused on drug resistance , as well as the social and cultural components of this resistance such as the relationship between poverty and the spread of resistant strains of bacteria . that can provide immunity against viral diseases have also transformed human health . The eradication of the smallpox virus in 1977 following a concerted global effort to vaccinate a large percentage of the worlds population is one example of the success of this biotechnology . Before the development of the vaccine , the virus was killing million people each Today , vaccines exist for many of the worlds most dangerous viral diseases , but providing access to vaccines remains a challenge . The polio virus has been eliminated from most of the world following several decades of near universal vaccination , but the disease has made a comeback in a handful of countries , including Afghanistan , and Pakistan , where weak governments , inadequate healthcare systems , or war have made vaccinating children impossible . This example highlights the global inequalities that still exist in access to basic medical care . Because viruses have the ability to mutate and to jump between animals and people , human around the world also face the constant threat of new viral diseases . has been for millions of deaths . In 1918 , a pandemic of the infected 500 million people , killing nearly percent of the human Not all strains are that deadly , but it remains a dangerous illness and one that vaccines can only partially Each year , the strains of the virus placed in the annual shot are based on predictions about the strains that will be most common . Because the virus mutates frequently and is by interactions between human and animal populations , there is always uncertainty about future forms of the

439 Reproductive Technologies Today , the idea of contraception is linked to the technology of birth control . The pill as we now know it , was not available in the United States until 1960 , but attempts to both prevent or bring about pregnancy through technology date back to the earliest human communities . Techniques used to control the birthrate are an important subject for medical anthropologists because they have significant cultural implications . Many cultures use natural forms of birth control practices to the spacing of births . Among the ! Kung , for instance , babies are breastfed for many months or even years , which hormonally suppress fertility and decrease the number of pregnancies a woman can have in her lifetime . In , New Guinea , men and women do not live with one another following a birth , another practice that increases the time between In contrast , cultures where there are social or religious reasons for avoiding birth control , including natural birth spacing methods , have higher birth rates . In the United States , the Act passed in 1873 banned contraception and even the distribution of information about contraception . Although the Act is a thing of the past , efforts in the United States to limit access to birth control and related medical services like abortion are ongoing . Many medical anthropologists study the ways in which access to reproductive technologies is affected by cultural values . Oaks ( 2003 ) has investigated the way in which activists on both sides of the abortion debate attempt to culturally define the idea of risk as it relates to women health . She notes that in the activists in the United States circulated misleading medical material suggesting that abortion increases rates of breast cancer . Although this claim was medically false , it was persuasive to many people and contributed to doubts about whether abortion posed a health risk to women , a concern that strengthened efforts to limit access to the Other forms of reproductive technology have emerged from the desire to increase fertility . The world of assisted reproduction , which includes technologies such as in vitro fertilization and surrogate nancy , has been the subject of many anthropological investigations . Marcia , a medical , has written several books about the growing popularity of in vitro fertilization in the Middle East . Her book , The New Arab Man ( 2012 ) explores the way in which infertility disrupts traditional notions of Arab masculinity that are based on fatherhood and she explores the ways that couples cultural messages about the importance of parenthood and religious disapproval of assisted CONCLUSION As the global population becomes larger , it is increasingly challenging to address the health needs of the worlds population . Today , in people in the world do not have access to adequate nutrition , the most basic element of good More than half the human population lives in an urban ment where infectious diseases can spread rapidly , sparking pandemics . Many of these cities include dense concentrations of poverty and healthcare systems that are not adequate to meet demand . 52 Globalization , a process that connects cultures through trade , tourism , and migration , contributes to the spread of pathogens that negatively affect human health and exacerbates political and economic inequalities that make the provision of healthcare more difficult . Human health is complex and these are daunting challenges , but medical anthropologists have a unique perspective to contribute to finding solutions . Medical anthropology offers a holistic

440 AN OPEN INTRODUCTION TO CULTURAL ANTHROPOLOGY tive on human evolutionary and adaptations as well as insights into the relationship between health and culture . As anthropologists study the ways people think about health and illness and the socioeconomic and cultural dynamics that affect the provision of health services , there is a potential to develop new methods for improving the health and quality of life for people all over the world . Discussion Questions This chapter describes several examples of diseases that result from interactions between biology and culture such as obesity . Why is it important to consider cultural factors that contribute to illness rather than placing blame on individuals ?

What are some other examples of illnesses that have cultural as well as biological causes ?

Many cultures have that provide explanations for illness that are not based in science . From a biomedical , the medical treatments provided in these cultures have a low likelihood of success . Despite this , people tend to believe that the treatments are working . Why do you think people tend to be satisfied with the effectiveness of the treatments they receive ?

How does poverty influence the health of populations around the world ?

Do you see this in your own community ?

Who should be responsible for addressing health care needs in impoverished communities ?

GLOSSARY Adaptive Traits that increase the capacity of individuals to survive and reproduce . evolution Describes the interactions between biology and culture that have human evolution . Biomedical An approach to medicine that is based on the application of insights from science , biology and chemistry . Communal healing An approach to healing that directs the combined efforts of the community toward treating illness . syndrome An illness recognized only within a specific culture . explanation Suggests that illnesses are caused by strong emotions such as fright , anger , or grief this is an example of a naturalistic . Epidemiological transition The sharp drop in mortality rates , particularly among children , that occurs in a society as a result of improved sanitation and access to healthcare . Cultural explanations about the underlying causes of health problems . The comparative study of cultural ideas about wellness , illness , and healing . Humoral healing An approach to healing that seeks to treat medical ailments by achieving a balance between the forces , or elements , of the body . Traits that decrease the capacity of individuals to survive and reproduce . Medical anthropology A distinct within the discipline of anthropology that investigates human health and health care systems in comparative perspective . Naturalistic Views disease as the result of natural forces such as cold , heat , winds , or an upset in the balance of the basic body elements . Personalistic Views disease as the result of the actions of human or supernatural beings . Placebo effect A response to treatment that occurs because the person receiving the treatment believes it will work , not because the treatment itself is effective .

441 Shaman A person who specializes in contacting the world of the spirits . Somatic Symptoms that are physical manifestations of emotional pain . Zoonotic Diseases that have origins in animals and are transmitted to humans . ABOUT THE AUTHOR is an anthropologist with research in the fields of comparative religion and psychological anthropology . She received a Master of Arts from Columbia University in the City of New York in Anthropology and has since been researching and teaching . Currently , is an instructor at Pasadena City College , teaching Cultural and Biological Anthropology . In her free time , enjoys traveling the world , visiting archaeological and cultural sites along the way . She and her husband are actively involved in animal rescuing , hoping to eventually found their own animal rescue for animals that are waiting to find homes . Notes . Gilbert , Humors , Hormones , and ( New York State University of New York Press , 1962 ) World Health Organization , Health Impact Assessment , Sally and Allison Brooks , The Revolution That Was A New Interpretation of the Origin of Humans , journal ofHuman Evolution 39 ( 1999 ) Center for Disease Control and Prevention , Adult Obesity Facts , Marjorie Whiting , A Cross Cultural Nutrition Survey ( Cambridge , MA Harvard School of Public Health , 1968 ) Ian . Prior , The Price of Civilization , Nutrition Today no . 1971 ) Steven Connor , Deadly malaria may have risen with the spread of agriculture , National Geographic , Jared Diamond , The Arrow of Disease , Discover Magazine , October 37 . World Health Organization , Cholera , 20 . 21 . George . and john Dewey , Evolutionary Response to Human Infectious Disease , 25 ( 1970 ) William , Plagues and People ( New York , 1976 ) Ian Barnes , Anna , Oliver , Mark Thomas . Ancient Predicts Genetic Resistance To Tuberculosis , Evolution 65 no . 2011 ) George , Acupuncture Its Place in Western Medical Science ( United Kingdom Merlin Press , 1998 ) George Foster , Disease in Medical Systems , American Anthropologist 78 no ( 1976 ) 775 . The An Anthropological Study of the Hill Tribes in ( Oxford Oxford University Press , 1947 ) 173 . Foster , Disease in Medical Systems , 775 . AJ . The Epidemiology of a Folk Illness in Hispanic America , 1964 ) Robert Trotter II , The Context of Community Morbidity Patterns , Ethnology 21 no . 1982 ) Frank . The Study of Disease in Relation to Culture The Among the of , Dialectical Anthropology 12 no . 1987 ) Witchcraft , Oracles and Magic Among the ( Oxford Oxford University Press , 1937 ) 70 .

442 PERSPECTIVES AN OPEN INTRODUCTION TO CULTURAL ANTHROPOLOGY 22 . 23 . 24 . 25 . 26 . 27 . 28 . 29 . 30 . 31 . 32 . 33 . 34 . 35 . 36 . 37 . 38 . 39 . 40 . 41 . 42 . 43 . Leonard , Medicine as an Ethnographic Category The of the New Guinea Highlands , Ethnology ( 1967 ) Elliott , Viewpoint Critical Perspectives on the Biomedical Model , inE . Rhodes , Hauser , and , Illness , and Patient Care ( Cambridge , UK Cambridge University Press ) Richard , Megan , and Verna Davis , Healing Makes Our Hearts Happy and Cultural Transformation among the ( Rochester , Inner Traditions , 1982 ) 34 . Michael Bliss , William A Life in Medicine ( Oxford Oxford University Press , 1999 ) 276 . William , The Faith That Heals , British Medical journal ( 1910 ) 1472 . Cara , The Placebo Phenomenon , Harvard Magazine . Ted . and Franklin Miller , Placebo Effects in Medicine , New England 373 ( 2015 ) Robert Bud , Antibiotics From to the Carefree Life and Back Again , in Medicating Modern Prescription Drugs in History , ed . Andrea Tone and Elizabeth Watkins ( New York New York University Press , 2007 ) Benson , Sherwood , Lam , and Carpenter , Study of the Therapeutic Effects of Intercessory Prayer ( STEP ) in Cardiac Bypass Patients A Randomized Trial of Uncertainty and Certainty of Receiving Prayer , American Heart 151 ( 2006 ) National Cancer Institute , Acupuncture , Mira , The Religious and Medicinal Uses of Cannabis in China , India , and Tibet , journal Drugs 13 ( 1981 ) and White , Cultural Conceptions Health and Therapy ( Netherlands , 1982 ) Dominic . Lee , Joan , and Arthur , Rethinking Depression An Ethnographic Study of the Experiences of Depression Among Chinese , Harvard Review 15 no ( 2007 ) Arthur , Rethinking Psychiatry From Cultural Category to Personal Experience ( New York The Free Press , 1988 ) Robert and . Cultural Formulation of Psychiatric Diagnoses The Spirits , and the Social Suppression of Memory A Complex Clinical Case from Bali , Culture , Medicine and Psychiatry 30 no . 2006 ) For more information about these studies , see . Leff et , The International Pilot Study of Schizophrenia Findings , Psychological Medicine 22 ( 1992 ) et , Schizophrenia Manifestations , Incidence and Course in Different Cultures A World Health Organization Study , Psychological Medicine Monograph Supplement 20 ( 1992 ) Sartorius et , Early Manifestations and tact Incidence of Schizophrenia in Different Cultures , Psychological Medicine 16 ( 1986 ) ack Martin , Scott Long , Karen , and Tait Medina , The Theory of Industrial Society and Cultural Schemata Does the Cultural Myth of Stigma Underlie the WHO Schizophrenia Paradox ?

American journal of Sociology 121 no . 2015 ) Barry , Victoria , Kelly , and Mark , Obesity Metaphors How Beliefs about Obesity Affect Support for Public Policy , The Quarterly 87 ( 2009 ) Peter Conrad and Kristen Barker , The Social Construction of Illness Key Insights and Policy Implications , journal and Social Behavior , 51 ( 2010 ) Peter , Is the Obesity Crisis Hiding a Bigger Problem ?

Talks April 2013 Retrieved from , re , diabetes . jennifer , Vishal Patel , Robert , Daniel Ortiz , Greg , and Thomas . Coates , Stigma in the Epidemic A review of the Literature and Recommendations for the Way Forward , AIDS 22 . 2008 ) Elizabeth , Sex , Drugs , HIV Lets Get Rational , TED Talks February ) and ,

44 . 45 . 46 47 . 48 . 49 . 50 . 51 . 52 . 53 . 54 . 55 56 57 . 58 . 59 . 60 . 61 . 62 . 443 United Nations , Poverty and AIDS What Really Driving the Epidemic ?

Maria , Koji , and Lorraine , Prevalence of Eating Disorders A Comparison of and Countries , General Medicine no . 2004 ) Fasting girls The Emergence as a Modern Disease ( Cambridge , MA University Press , 1988 ) Anne Becker , Television , Disordered Eating , and Young Women in Negotiating Body Image and Identity during Rapid Social Change Culture , Medicine and Psychiatry , 28 no . 2004 ) Sing Lee , Reconsidering the Status of Anorexia as a Western Syndrome , Social Science ea Medicine 42 no . 1996 ) Swallowing Frogs Anger and Illness in Northeast Brazil , Medical Anthropology Quarterly no . 1994 ) Robert Bud , Antibiotics From to the Carefree Life and Back Nancy Hughes , Death Without Weeping The Violence Life in Brazil ( Berkeley University of California Press , 1989 ) World Health Organization , Resistance , David , Smallpox The Fight to Eradicate a Global Scourge ( Berkeley University of California Press , 2003 ) Jeffery , David Baltimore , Peter , Howard , David , Robert Webster , and Ian Wilson , Reconstruction of the 1918 Virus Unexpected Rewards from the Past , no . 2012 ) Jeffrey and David , The Mother of All Pandemics , Emerging Infectious eases , 12 ( 2006 ) Suzanne Clancy , Genetics of the Influenza Virus , Nature Education , 2008 ) 83 . For more about these and other examples , see Carol , Ethnography and Birth ( New York Academic Press , 1982 ) Oaks , The Social Politics of Health Risk Warning Competing Claims about the Link between Abortion and Breast Cancer , in Risk , Culture , and Health Inequality Shifting of Danger and Blame , bara Herr and Oaks ( 2003 ) Marcia , The New Arab Man Emergent , Technologies , and Islam in the Middle East ( Princeton , Princeton University Press , 2012 ) Food and Agriculture Organization of the United Nations , The Multiple Dimensions of Food Security , World Health Organization , Urbanization and Health , Bulletin of the World Health Organization , 88 ( 2010 )